Service Representative Customer
Resume:
Monica Calhoun
Nashville, TN **214
adsddz@r.postjobfree.com
Education:
B.S. in Criminal Justice 2018
M.S in Criminal Justice 2020
Summary:
Exceptional candidate with extensive experience in customer service, pharmacy, fraud, and administration with broad-based experience in records management, and switchboard operations. Management supervising and mentoring personnel, proficient with Microsoft Office (Word, Excel, PowerPoint, Peachtree, and Mac systems.
Professional Experience:
Anthem Blue Cross Blue Shield, Nashville, TN
10-2018 to 8-2022
Working with a variety of Medicare Advantage plans, Medicaid, and Duals members to assist with questions about their plans. Working to answer questions about pharmacy, vision, and dental benefits. Working in enrollment to process applications checking to make sure all-important data and documents are obtained to complete the process. Checking Medicaid and Medicare database (Marx) to check the status of Parts A/B/C and D. Outbound calls to obtain any needed information. Make sure to send out the welcome packages, other documents, and information needed for the member to understand their plans and benefits. Assigning doctors, sending out I'd cards, updating demographic information, looking up medication copays and costs. Using email, and text as an additional way of communication. Handling complaints and filing grievances for members to go to Medicare.
Sunrise System Inc, Nashville, TN
8-2017 to 12-2017
Client Service/ Credit and Debit Association.
Working closely with the Engineer team to process specifications on various engines. Working with distribution and clients to maintain and build relationships and retention of clients. Working to de-escalate issues or problems that arise. Doing extensive research to locate any parts or engines needed domestically and internationally. Working on unresolved escalations to find needed parts globally for parts that are not in stock locally. Maintaining accounts for suppliers as well as monitoring accounts for any issues of fraud. Working with the planning department to have parts released for engines. Working on crediting accounts and debiting accounts to ensure the proper balance is seen on the bottom line.
Seven-Seven Inc, Nashville, TN
Client Service- Credit and Debit associate
12-2016 to 9-2017
Training new hires, inbound and outbound calls to customers and merchants. Ensuring that the customer's orders are handled correctly. Handling incoming email requests from customers. Address concerns about balances, holdings, and activities on the account. Maintaining the security of the accounts while answering questions on the account. Working with the clients on My Total Picture, Quicken, and Mobil Deposits capture. Assisting the clients with password resets to gain access back into clients' accounts. Navigating the clients through the New Platform of Neo to monitor stock market accounts. Work with the branches and the financial advisors for the best interest of the clients.
Postmates, Nashville, TN
Customer Service Representative
02-2016 to 09-2016
Training new hires inbound and outbound calls to customers and merchants. Ensuring the customer's orders are handled correctly. Handling incoming email requests from customers. Placing an order for clients. Handling social media requests and working to make sure negative information is handled while ensuring a positive outcome for the customer and Postmates. Working with 1-star clients' (celebrities') feedback to resolve issues that customers may have and resolve them. Working with the couriers on issues that may occur out in the field to manage a smooth delivery for the clients. One of two people exclusively handling celebrity and political clients for any issues, monitoring their financial information to ensure no fraudulent activity on accounts. Maintain company credit cards with high limits used to make purchases for clients. Training new hires.
CSC/ACS Nashville, TN
Customer Service Representative
4-2015 to 2-2016
Processing incoming mail. Processing Insurance payments. Updating information on accounts. Updating demographic information. Policy reinstatements. Assisting members with their life insurance policies. Making changes needed, setting up policies for payout. Checking on fraud claims.
Cigna, Nashville, TN
Customer Service Representative
8-2014 to 2-2015
Worked with customers on medication refills. Assisted customers with the selection of insurance claims. Provided quality customer service. Assisted with system changes to ensure better services for the customer. Speak with healthcare professionals on behalf of the customer to resolve issues. Assisted customers with locating the best provider for their needs.
American Home Patient, Nashville, TN
Customer Service Representative
5-2010 to 7-2013.
Accurately log information from inbound and outbound calls/ Communicated with customers on CPAP supplies. Make sure to monitor accounts for needed refills. Up sales supplies needed to make the CPAP experience was a good one. Verify insurance and financial credit and collect fees. Complete admission requirements. Qualify patients for reimbursement. Determine changes for services and products ordered. Maintain client base for continued material and supplies to keep patients stocked up.
Health Spring, Nashville, TN
Provider Service Representative
04-2008 to 7-2009
Work with doctors and pharmacists about concerns. Processing information and enrollment information. Going through pharmacist and doctor contracts to answer questions and address concerns. Explain Medicare and Medicaid process on payments and fees. Answer questions about claims and process corrected claims and other problems that may arise.
CVS Caremark, Nashville, TN
Customer Service Representative
7-2004 to 4-2008
Provide excellent service and good judgment while taking inbound calls from high-profile clients, members, pharmacists, and doctor's offices. Worked closely with the pharmacist on claims processing and Medicare Part D. claim processing, including prior authorizations, claims processing, and billing. Placed prescription orders for members, checked status or orders, and answer billing questions. Worked with investigation teams for fraud, doctor, and prescription shopping. Fraud on stolen medications. Explaining pharmacist contracts on medication pay per pill.
References furnished upon request.
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